GGz Breburg

An important aim of the new mental health act implemented in the Netherlands in 2020 was to shift the focus from hospitalization to treatment. The act provides an option for patients' compulsory treatment at home (CTH). Unlike compulsory community treatment (CCT), which allows mental health workers to hospitalize patients involuntarily if they do not comply with treatment. CTH is not provided elsewhere in the world. This case report concerns a patient who, to avoid hospitalization, received CTH in the form of compulsory medication and was able to recover at home. Retrospectively, she and the mental health team both positively evaluated this use of CTH. The parties involved all concluded that CTH restricted the patient's autonomy less than hospitalization, it did not influence the therapeutic relationship, and the CTH could be delivered in a way that it did not compromise participants' safety. This case report shows that, in some situations, CTH can avoid hospitalization. Care should nonetheless be taken to assess its appropriateness, to discuss any preconditions, and to evaluate the use of compulsory treatment in dialog with the patient and significant others.

Trust is among the most critical factors in buyer−supplier relationships. In an effort to understand the origins of trust, power has become the focus of a burgeoning body of literature. However, research on the association between power and trust has been plagued by inconsistencies in terms of whose power and trust are being examined, which has led to confusion and hindered cumulative progress. We address this issue by disentangling the effect of the focal organization ( actor effect ) from the effect specific to its partner ( partner effect ) and accounting for both simultaneously. We further theorize and show that the partner’s level of self-promotion communication about his or her own achievements and credentials moderates both actor and partner effects, thus adding knowledge about a contingency that accounts for a considerable degree of variation in the linkage between power and trust. Using multi-informant, dyadic survey data paired with archival information scraped from firms’ webpages, we find that (i) actors low (vs. high) in power tend to place more trust (ii) while simultaneously eliciting higher levels of trust from their partners; however, (iii) these effects differ markedly depending on the partner’s level of self-promotion communication. Our study offers a novel, integrative perspective on power and trust, and we elaborate on its important implications for understanding buyer−supplier relationships.

'Positive Health' and 'recovery' seem to cover similar multidimensional health perspectives focussing on capabilities instead of incapabilities. The My Positive Health questionnaire and Individual Recovery Outcomes Counter were initially developed as dialogue tools, but nowadays also used as self-reported questionnaires. Structural validity of these dialogue tools was assessed in earlier research resulting in the 42-items Positive Health questionnaire (PH42) and 12-items Individual Recovery Outcomes Counter (I.ROC12). As a next step, we investigated their construct validity. An observational cross-sectional study was conducted in a representative general Dutch population (LISS-panel) determining (1) Coherence between the PH42 and I.ROC12 using correlation coefficients; (2) Convergent validity by testing hypotheses for PH42 and I.ROC12 with external health-related questions using correlation coefficients; (3) Discriminative validity for subgroups gender, age, educational level and healthcare use. (1) Nine out of twelve correlations between PH42 and I.ROC12 factors were substantial (> 0.5). (2) Hypotheses for PH42 and I.ROC12 factors with health-related questions were confirmed for 80% and 75%, respectively. (3) Scores on all factors increased (i.e., better health) from low to high educational level and decreased from no healthcare use to healthcare received from (medical) specialists. Only the factor physical health and functioning showed a continuous decrease in scores with increasing age. Women scored lower only on physical health and functioning. Convergent validity is adequate and discriminative validity is adequate for educational level and healthcare use supporting the conclusion that the PH42 and I.ROC12 are useful instruments to measure Positive Health in a general population.

BackgroundSocial recovery (SR) in people with psychotic disorders involves taking on social roles and completing daily tasks. Functional recovery (FR), particularly executive functions, is critical for these roles. Psychotic disorder patients often experience severe cognitive impairments, especially in executive functions. This study investigates the relationship between functional and social recovery in individuals with psychotic disorders and examines the effect of employment status on this association.MethodThis cross-sectional study involved people with a psychotic disorder. SR was measured using the WHO-DAS, divided into Daily Functioning (DF) and Social Functioning (SF) scales. FR was measured using the BRIEF-A and the TOL. Employment status was categorized into Non-active, Otherwise Active, and Active. The Likelihood-ratio Test (LRT) was used for model selection.ResultsData from 251 participants (mean age 41.5) showed that the BRIEF-A affected both DF and SF, while the TOL only affected DF. Only being Otherwise Active influenced DF. Employment status had no influence on SF. Being Otherwise Active positively influenced perceived disabilities in Daily Functioning.ConclusionMeasuring executive functions using both performance-based and self-report measures is important. Both measures are associated differently with perceived disabilities in daily and social functioning. Being a volunteer or looking for a job positively influences perceived disabilities in Daily Functioning.

BackgroundAlthough clinical guidelines prioritize the treatment of depression and anxiety in young persons, there is accumulating evidence that the presence of symptoms of borderline personality disorder (BPD) is associated with the limited effectiveness of these standard treatments. These findings stress the need for interventions addressing early-stage BPD in young people with presenting symptoms of anxiety and depressive disorders. The aim of this study is to investigate the (cost-)effectiveness of an early intervention programme for BPD (MBT-early) compared to first-choice psychological treatment for depression and anxiety according to Dutch treatment guidelines (CBT), in adolescents with either depression, anxiety, or both, in combination with early-stage BPD.MethodsThis study is a multi-centre randomized controlled trial. A total of 132 adolescents, presenting with either depression, anxiety, or both and significant BPD features will be randomized to either MBT-early or CBT. The severity of BPD, symptoms of depression and anxiety, personality, social and academic functioning, and quality of life will be assessed at baseline, end of treatment, and at 12-, 18-, and 24-month follow-up, along with medical costs and costs of productivity losses for cost-effectiveness analyses.DiscussionThis study will provide an empirical evaluation of the potential surplus value of early intervention in young people for whom treatment oriented at common mental disorders like anxiety and depression may be insufficient given their underlying personality problems.Trial registrationNetherlands Trial Register, NL9569. Registered on June 15, 2021.

ABSTRACTIntroductionUsing the ‘positive health’ perspective has emerged in general healthcare. Conceptual similarities exist with the ‘recovery’ perspective in mental healthcare. Both concepts are multidimensional and focus on capability. The My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) tools were developed fordialogues. These tools might be useful forquantitively measuringthepositive healthconstruct for monitoring and scientific purposes as well. We aimed to investigate this.MethodAn observational cross-sectional study was conducted in a representative general Dutch population (the LISS panel) to investigate factor structures and internal consistency from the 42-items MPH and 12-items I.ROC. After randomly splitting the dataset, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied. Spearman correlation coefficient between both tools’ total scores was calculated.Results2,457 participants completed the questionnaires. A six-factor structure was extracted for MPH (PH42) and a two-factor structure for I.ROC (I.ROC12). Explained variances were 68.1% and 56.1%, respectively. CFA resulted in good fit indices. Cronbach’s alphas were between 0.74 to 0.97 (PH42) and 0.73 to 0.87 (I.ROC12). Correlation between the total scores was 0.77.ConclusionBoth PH42 and I.ROC12 are useful to quantitatively measure positive health aspects which can be summarised in sum scores in a general population. The dimensions found in this study and the corresponding item division differed from the dimensions of the original dialogue tools. Further research is recommended focussing on item reduction for PH42, factor structure of I.ROC and assessment of construct validity (in a general population) in more depth.

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly in treatment intensity: day hospital mentalization-based treatment (MBT-DH) and intensive outpatient mentalization-based treatment (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include the full intention-to-treat sample of the original trial of N= 114 randomized BPD patients (MBT-DH n= 70, MBT-IOP n= 44), who were assessed at baseline and subsequently every 6 up to 36 months after start of treatment. Outcomes were general symptom severity, borderline features, and interpersonal functioning. Clinical severity was examined in terms of severity of BPD, general symptom severity, comorbid symptom disorders, comorbid personality disorders, and cluster C personality features. None of the severity measures was related to treatment outcome or differentially predicted treatment outcome in MBT-DH and MBT-IOP, with the exception of a single moderating effect of co morbid symptom disorders on outcome in terms of BPD features, indicating less improvement in MBT-DH for patients with more symptom disorders. Overall, patients with varying levels of clinical severity benefited equally from MBT-DH and MBT-IOP, indicating that clinical severity may not be a useful criterion to differentiate in treatment intensity.

Background: European differences in Mental Healthcare systems (MHS) and European challenges within MHS, like migration, climate change and lack of qualified professionals, require collaboration between stakeholders from individual countries within the European Union. Purpose: To exchange information between national and international associations and inspire Dutch clinical psychologists in training. Method: A digital event was organized and three renowned associations from both Portugal and The Netherlands presented their organization and current developments. This input was used in a discussion round where participants from both countries participated. Conclusion: This event provided positive outcomes on multiple levels, including being educational for specialists in training, building and maintaining the relationship between the professionals and association of both countries and providing new and inspiring perspectives that can help mutual MHS. The differences show the work that lies ahead, to create more European uniformity within MHS and to further benefit from international collaboration.

SamenvattingDit artikel geeft een overzicht van effectieve suïcidepreventie-interventies en hun betekenis voor het Nederlandse werkveld en de Landelijke Agenda Suïcidepreventie. We bespreken een in 2020 gepubliceerde systematische review die het effect van preventieve interventies op suïcides en suïcidepogingen evalueerde, en geven een update van de ontwikkelingen daarna. Zestien onderzoeken met 252.932 participanten lieten zien dat er effectieve suïcidepreventie-interventies bestaan, zowel voor het voorkómen van suïcides, als van suïcidepogingen. Multi-level-interventies hebben grotere effecten dan uni-level-interventies. Vooral keteninterventies die nadrukkelijk de verbinding tussen identificatie van mensen met suïciderisico op populatieniveau en toegang tot specialistische zorg leggen, verdienen landelijke prioriteit. Een digitaal beslissingsondersteunend instrument voor hulpverleners en ketenpartners van alle niveaus kan uitkomst bieden. Dit instrument werd ontwikkeld binnen SUPREMOCOL, een onderzoek naar de effectiviteit van een systeeminterventie voor suïcidepreventie, uitgevoerd in de provincie Noord-Brabant, dat significante resultaten had in het voorkómen van suïcide. Het is het enige wetenschappelijk onderzoek in Nederland dat expliciet suïcide en suïcidepogingen als uitkomsten van een suïcidepreventie-interventie evalueert. In Nederland is dat nodig in het kader van de Landelijke Agenda Suïcidepreventie.

Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between PK parameters and BMI in children and adolescents with ASD and behavioral problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side effects and drug effectiveness. Twenty-four children and adolescents (15 males, 9 females) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side effects and drug effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro-aripiprazole concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-hour AUCs were analyzed to predict outcomes using generalized and linear mixed-effects models. For both aripiprazole and de-hydro-aripiprazole, one-compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro-aripiprazole) trough concentrations best predicted higher BMI z-scores (P < .001) and higher Hb1Ac levels (p=0.03) during follow-up. No significant association was found between sum concentrations and effectiveness. Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioral problems.